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GP Info
Common ENT Questions & Answers
Why do children get frequent ear infection following colds?
The Eustachian tube connects the middle ear to the back of the nose. The function of this tube is to equalize the pressure in the middle ear with the outside, which is essential for normal functioning of the ear. Malfunctioning of this tube due to any of the various reasons can result in problems with the middle ear.
During a cold, the entire upper respiratory system becomes swollen and filled with mucous, and often a significant virus and bacteria load. This fluid disrupts the function of the Eustachian tubes. In small children who may have short, narrow tubes, complete blockage sometimes occurs, resulting in formation of fluid in the middle ear. Overly wide Eustachian tubes can also cause problems, since they allow bacteria-laden nose and throat secretions to enter the middle ear. Finally large adenoids, which act as a repository for bacteria, sit adjacent to the internal Eustachian tube opening. Either way the stage is set for a middle ear infection, known medically as Otitis Media.
How common are ear infections?
Ear infections associated with earache are very common in early childhood. By age three, two-thirds of children have had an ear infection, and half of this group gets them repeatedly. In infants and preschoolers, the middle ear, which lies behind the eardrum, is most prone to infection (otitis media). Middle ear infections typically develop when a child has already been suffering from a cold for a few days. The symptoms often come on suddenly, with an abrupt spike in fever that coincides with the development of severe ear pain. The symptoms may be subtle, though some children simply become fussy or listless, stop eating and develop a slight (if any) fever. Children too young to complain often pull or scratch at their ears. Severe infection may rupture the eardrum and cause a discharge of pus or clear fluid from the ear canal. If your child has had one or more ear infections, be alert for recurrences especially during cold, flu and allergy seasons. Children who had their first bout of otitis media as babies are more likely to suffer repeated middle ear infections throughout childhood.
How are ear infections diagnosed and treated?
In most cases, an ENT Specialist can diagnose otitis media by looking into the child’s ear with an otoscope (a hand-held viewing device). A test called Tympanometry may also be performed to check for air pressure in the middle ear and accumulation of fluid or pus. Usually, a course of appropriate antibiotics will clear the infection. Sometimes one antibiotic fails to clear the infection and the doctor may want to try another antibiotic. At this stage some ENT Specialists puncture the eardrum with a needle, which relieves symptoms by allowing fluid to drain from the middle ear and permits the doctor to identify the responsible bacteria. Many children continue to have fluid in the middle ear for several months following the middle ear infections. This may result in reduced hearing. Such children will need minor surgery to drain their ears and insertion of small tubes called Grommets. Children who have repeated, severe ear infections should have their hearing checked regularly, since the condition can interfere with early speech and language development. Recurrent infections can also be an indication for grommet tube placement.
Does hearing get affected with frequent ear infections?
Most middle ear infections in children if treated adequately do not cause any lasting hearing deficit. But in children and adults, chronic ear problems that fail to resolve with medical treatment over a prolonged period may result in hearing deficiency of varying degrees. Some of these patients may be left with a perforated eardrum or small bones of the middle ear may be damaged due to chronic infections. These patients will then require surgery to repair their eardrums or the damaged little bones to restore hearing.
Why do children get nosebleeds and what is the treatment?
Most commonly, nosebleeds in children are spontaneous and occur from the anterior part of the nose. This part of the nose quite often has a bunch of superficial blood vessels called little’s area. Slight trauma like nose picking can result in the rupture of these vessels and cause nosebleeds. Similarly excessive drying or congestion due to colds, or a direct knock on the nose can all result in nosebleeds. Pinching the soft tip area of the nose, application of ice, and taking a cold drink will all help to stop a nosebleed. Certain decongestant nasal drops or gels are sometimes prescribed for occasional episodes. In children who get regular nosebleeds the most effective treatment is cautery to the nose. It is a simple treatment, takes few minutes and is carried out by ENT Specialists in their clinics. It is extremely rare for children to require anything more than a simple cautery to the nose for nosebleeds. However all children who get recurrent or severe nosebleeds must be examined by an ENT Specialist to decide the further course of treatment. Following cautery, Vaseline is often prescribed for simple application with a cotton bud to the inside of the nose for a couple of weeks. This stops crusting and breaks the cycle of crusting and bleeding.
What is the reason for frequent sinus congestions?
Chronic sinusitis is a recurrent or persistent infection of the paranasal sinuses. The sinuses are air cells contained within the facial bones. The average person can produce up to 500ml of secretions from the sinus mucosa during one day. This is usually not noticeable, unless it becomes thick, infected, or voluminous. The sinuses open directly into the nasal cavities through small openings. It is when these openings become obstructed that sinusitis develops. The most common causes of sinus obstruction are the common cold, allergic Rhinitis, non-allergic Rhinitis, and anatomic causes of blockage, such as nasal septal deviation or concha bullosa. Acute infections are characterized by purulent runny nose and post- nasal drip, mid-facial pain or headache, nasal congestion and fever. The sinus infections are usually treated with antibiotics and decongestants for a suitable period depending on the patient’s response. If the medical treatment fails then surgery is required. With advancements in the field, this kind of surgery is now done using various telescopes with good results
Why do people snore and what is the treatment?
Forty-five percent of normal adults snore at least occasionally, and 25 percent are habitual snorers. Problem snoring is more frequent in males and overweight people and it usually grows worse with age. Snoring occurs when floppy tissue in the airway relaxes during sleep and vibrates. Most snoring is caused by an enlarged soft palate and uvula at the back of the mouth, although other factors like the tongue, tonsils and adenoids and blocked nose due to deviated nasal septum or polyps can also contribute to snoring.
Non-surgical approaches include weight loss and other lifestyle modifications such as avoiding alcohol before retiring. An endoscopic examination helps the ENT Surgeon to determine the actual site of snoring and the type of surgery suitable for the individual. A variety of surgical treatments are available. Sometimes simple nasal surgery or removal of tonsils and adenoids may be all that is required. However in most adults surgery on the floppy and bulky soft palate is required. In general re-shaping and stiffening of the soft palate is done. Depending on the surgeon's preference traditional surgery, laser, radiofrequency, somnoplasty and various other methods are used to achieve the same end result with each method having its advantages and disadvantages. In our clinic we find traditional surgical treatment with reduction of redundant tissue in the throat has the best short and long term results. Obstruction of the nose and nasal airway can also contribute to snoring. If so surgical treatment of the nose may be performed at the same time for best results. A chronically snoring child should be examined for problems with his or her tonsils and adenoids. A Tonsillectomy and Adenoidectomy may be required to return the child to full health. These are all very safe procedures and the results are generally excellent.
What are allergies and how do they affect the nose?
An allergy is a condition that causes the body to respond to harmless substances in the environment as though they are harmful to the body. These substances are referred to as allergens. The body's immune system recognizes the presence of allergens and starts a reaction to prevent their invasion. In most people this is not a problem. However in some the immune system is overactive and identifies normally harmless particles as dangerous, producing an excessive reaction that actually causes inflammation. This inflammation in the nose is referred to as Allergic Rhinitis. The most common symptoms of an allergy in the nose are sneezing, runny nose, nasal congestion, itchy nose, and recurring sinus problems. Occasional attacks of nasal allergy can be treated with anti-allergy tablets and sprays. However for those who have regular attacks or persistent allergy in the nose a full assessment test to determine what they are allergic to and a long term treatment plan may be required.
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